What every surgeon should know regarding asbestos-related disease

Our plain-English summary of What every surgeon should know regarding asbestos-related disease, by U.F. Gruber (European Surgical Research. Europäische Chirurgische Forschung. Recherches Chirurgicales Européennes, 1986).

The study

• Author: U.F. Gruber
• Journal: European Surgical Research. Europäische Chirurgische Forschung. Recherches Chirurgicales Européennes
• Published: 1986;18(3-4):207-12
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001181).

Abstract

Long-lasting occupational exposure to asbestos dust may cause pleural disease, asbestosis, bronchogenic carcinoma and mesothelioma. Many years elapse from first exposure to the appearance of symptoms. Almost all these diseases are the result of dusty working conditions 20-40 years ago. The pathological sequelae are usually irreversible and can progress after exposure ceases. There is no satisfactory treatment. Prevention is the only practical way. In spite of the fact that the general public is invariably exposed to small amounts of the material, asbestos is not a public health problem. Exemptions are the buildings not properly cared for containing sprayed asbestos. But even living in such buildings is calculated to produce a negligible risk of death. Asbestos-related diseases occur where long-lasting inhalation of high amounts of fine asbestos dust has occurred. There is no evidence to indicate that ingested asbestos fibers represent a major health problem. Industry is now replacing asbestos in many products by other fibers. Natural and synthetic organic materials used in fiber cement products are unable to reach the alveoli. They are not cancerogenic and there is no reason to believe that such fibers cause chronic pulmonary disease.

In plain English

This 1986 article was a short review for practising surgeons on asbestos-related disease; the author stated that no original data were provided. It described asbestosis, asbestos pleural disease, lung cancer, and pleural and peritoneal mesothelioma. The author described four relatively young people who had total pleurapneumonectomy for mesothelioma but had no mesothelioma or other malignancy and were left severely disabled. The author wrote that mesothelioma is definitely associated with crocidolite and amosite exposure and that cases from chrysotile exposure alone seem very rare. Citing other sources, the author wrote that 15-30% of mesotheliomas arise without any asbestos association. Citing Doll and Peto, the author reported that exposure in buildings with sprayed asbestos was seldom more than 0.0005 fibers/ml air above background; this level for a working week in an office for 20 adult years, or about 10 years at school, was calculated to give a lifetime risk of death of 1 in 100,000. The author concluded that asbestos is not a public health problem, except in poorly kept buildings containing sprayed asbestos, and that prevention is the only practical approach.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review with no original data, written for surgeons
• Who was studied: No study population. The review was addressed to practising surgeons and summarized published literature.
• Exposure: Asbestos in general: chrysotile ('white' asbestos, from serpentine rock) and the amphibole group (crocidolite or 'blue', amosite or 'brown', and anthophyllite, tremolite and actinolite), mainly through occupational inhalation
• Main results:
  • As an example, the author described four relatively young people who had total pleurapneumonectomy for mesothelioma at a European thoracic surgery clinic but had no mesothelioma or other malignancy. They were left severely disabled.
  • The author stated that mesothelioma is definitely associated with crocidolite and amosite exposure. Citing another study, the author added that cases from chrysotile exposure alone seem very rare.
  • Citing other sources, the author stated that 15-30% of mesotheliomas arise without any asbestos association
  • The author stated that pleural plaques are not precursors of malignant change and serve as markers of exposure
  • In the author's view, an excess of lung cancer will only occur if asbestosis has also occurred
  • Citing Doll and Peto, the author reported that exposure inside buildings containing sprayed asbestos is seldom more than 0.0005 fibers/ml air above background
  • Citing Doll and Peto, exposure at this level for a working week in an office for 20 years of adult life, or for about 10 years at school, was calculated to produce a lifetime risk of death of 1 in 100,000
  • The author stated that mesothelioma prognosis is uniformly fatal, usually within about 1-2 years
  • The author stated that the risk from drinking water containing asbestos is negligible
  • The author reported that research on replacement fibers showed that almost all fibers reaching the alveoli, both mineral and man-made mineral fibers, are carcinogenic in vitro, in vivo or both
• The authors' conclusion: The author concluded that asbestos is not a public health problem for the general public, except for poorly maintained buildings containing sprayed asbestos
• Limitations the authors state:
  • The author stated that the available data were too few to draw conclusions about cancers other than lung cancer, mesothelioma, and possibly laryngeal and oesophageal cancer

Topics

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Bronchogenic Carcinoma, Mesothelioma, Alveoli.

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• Occupational cancer in Canada: what do we know? — K. Teschke, M.C. Barroetavena (1992)
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